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Christoph F. Dietrich - One of the best experts on this subject based on the ideXlab platform.

  • Nomogram for predicting transmural Bowel Infarction in patients with acute superior mesenteric venous thrombosis.
    World journal of gastroenterology, 2020
    Co-Authors: Meng Jiang, Chun-qiu Pan, Yu-fei Ren, Xin-wu Cui, Christoph F. Dietrich
    Abstract:

    BACKGROUND The prognosis of acute mesenteric ischemia (AMI) caused by superior mesenteric venous thrombosis (SMVT) remains undetermined and early detection of transmural Bowel Infarction (TBI) is crucial. The predisposition to develop TBI is of clinical concern, which can lead to fatal sepsis with hemodynamic instability and multi-organ failure. Early resection of necrotic Bowel could improve the prognosis of AMI, however, accurate prediction of TBI remains a challenge for clinicians. When determining the eligibility for explorative laparotomy, the underlying risk factors for Bowel Infarction should be fully evaluated. AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT. METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study. They were grouped as training and external validation cohort. The 207 cases (training cohort) from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data, and a nomogram was subsequently developed. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness in the training and external validation cohort. RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort: The decreased Bowel wall enhancement (OR = 6.37, P 2 mmol/L (OR = 3.14, P = 0.009) and previous history of deep venous thrombosis (OR = 6.37, P < 0.001). Incorporating these four factors, the nomogram achieved good calibration in the training set [area under the receiver operator characteristic curve (AUC) 0.860; 95%CI: 0.771-0.925] and the external validation set (AUC 0.851; 95%CI: 0.796-0.897). The positive and negative predictive values (95%CIs) of the nomogram were calculated, resulting in positive predictive values of 54.55% (40.07%-68.29%) and 53.85% (43.66%-63.72%) and negative predictive values of 93.33% (82.14%-97.71%) and 92.24% (85.91%-95.86%) for the training and validation cohorts, respectively. Based on the nomogram, patients who had a Nomo-score of more than 90 were considered to have high risk for TBI. Decision curve analysis indicated that the nomogram was clinically useful. CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI. Using the model, the risk for an individual patient inclined to TBI can be assessed, thus providing a rational therapeutic choice.

Seung Huh - One of the best experts on this subject based on the ideXlab platform.

  • Treatment outcomes and risk factors for Bowel Infarction in patients with acute superior mesenteric venous thrombosis
    Journal of vascular surgery. Venous and lymphatic disorders, 2017
    Co-Authors: Hyung-kee Kim, Deokbi Hwang, Sujin Park, Jong-min Lee, Seung Huh
    Abstract:

    Abstract Objective The prognosis of acute superior mesenteric venous thrombosis (SMVT) remains obscure. We aimed to investigate the treatment outcomes and possible risk factors for Bowel Infarction in these patients. Methods We retrospectively included 66 patients with acute SMVT between January 2002 and June 2016. Each patient underwent contrast-enhanced computed tomography as part of the initial diagnosis. The standard protocol for management included a nonsurgical approach with early anticoagulation and selective exploration. For the analysis of the risk factors for Bowel Infarction, patients were divided into Bowel resection (BR) and non-BR groups. Outcomes of interest were causes of SMVT, percentage of BR after nonsurgical treatment, and risk factors for BR. Results Of 66 patients, 15 (23%) underwent BR; of these, 9 underwent urgent BR because of peritoneal signs and definite findings of Bowel Infarction on computed tomography scan, 4 underwent BR after failed anticoagulation, and 2 underwent BR because of delayed stricture. Clinically, vomiting ( P  = .003), abdominal distention ( P  = .003), rebound tenderness ( P  = .005), and leukocytosis ( P  = .001) were associated with BR. On radiologic examination, Bowel wall thickening ( P P P  = .007) were associated with BR. Twenty-seven (41%) patients presented with isolated SMVT, and the remaining patients demonstrated a coexisting portal vein (PV) thrombosis in addition to SMVT. All 15 BRs occurred in patients with combined PV thrombosis and SMVT ( P P  = .028 for superior mesenteric vein; P  = .025 for PV). BR was performed in 1 (4%) of 24 patients with transient risk factors compared with 14 (33%) of 42 patients without transient risk factors ( P  = .006). Three patients (4.5%) died in the hospital. Conclusions In patients with acute SMVT, the extent of thrombus and etiology were associated with the severity of acute SMVT. Patients with transient risk factors and isolated SMVT tended to have a benign disease course. With early anticoagulation, acute SMVT does not seem to have the grave prognosis that is associated with arterial thrombosis.

K Higby - One of the best experts on this subject based on the ideXlab platform.

  • Delayed diagnosis of Bowel Infarction secondary to maternal midgut volvulus at term.
    Obstetrics and gynecology, 1998
    Co-Authors: A M Ventura-braswell, A J Satin, K Higby
    Abstract:

    Intestinal volvulus is responsible for 25% of acute Bowel obstructions in pregnant women but only 3-5% in nonpregnant patients. Pregnancy may hinder early diagnosis. A woman in early labor subsequently developed hypotension and a nonreassuring fetal heart rate tracing. Emergency cesarean was performed and a live infant was born. At surgery, the patient was noted to have ascites, necrotic Bowel, and a congenital gut malrotation with a complete midgut volvulus. Several congenital peritoneal bands were lysed, the volvulus was reduced, and 184 cm of small Bowel were resected. This patient represents a case of midgut volvulus with Bowel Infarction and necrosis secondary to congenital malrotation of the gut.

  • Delayed diagnosis of Bowel Infarction secondary to maternal midgut volvulus at term.
    Obstetrics & Gynecology, 1998
    Co-Authors: A M Ventura-braswell, A J Satin, K Higby
    Abstract:

    Abstract Background: Intestinal volvulus is responsible for 25% of acute Bowel obstructions in pregnant women but only 3–5% in nonpregnant patients. Pregnancy may hinder early diagnosis. Case: A woman in early labor subsequently developed hypotension and a nonreassuring fetal heart rate tracing. Emergency cesarean was performed and a live infant was born. At surgery, the patient was noted to have ascites, necrotic Bowel, and a congenital gut malrotation with a complete midgut volvulus. Several congenital peritoneal bands were lysed, the volvulus was reduced, and 184 cm of small Bowel were resected. Conclusion: This patient represents a case of midgut volvulus with Bowel Infarction and necrosis secondary to congenital malrotation of the gut.

Prabal Roy - One of the best experts on this subject based on the ideXlab platform.

D Temperley - One of the best experts on this subject based on the ideXlab platform.